Toddler's death provokes outrage in Pakistan

After his daughter was given a fatal dose of anaesthetic, Aqeel Malik's campaign against hospital negligence has reached the country's highest court.

A family photo shows Munazza and Aqeel Malik with their daughter, Imanae, 3, who died after a lethal injection at a Lahore hospital.

LAHORE // Aqeel Malik, 29, had big plans for his daughter, Imanae. He wanted her to become an artist or a sculptor. He wanted her to study at Oxford University or Cambridge. He wanted his only child to always live close by. "She was a brilliant kid," he said, recalling how she could easily work laptops, iPods and the internet, even at the age of three.

But Imanae's life was cut short when in November, a day after Eid, the toddler was rushed to one of Lahore's most prestigious private hospitals with burns to her wrist and given a fatal dose of anaesthesia. An inquiry ordered by the provincial Punjab government found that Imanae was given two intravenous injections of a sedative and one injection of an anaesthetic, which according to medical protocol is never administered for minor burns. The anaesthetic, since it was given without respiratory support, killed her immediately.

The report blamed the hospital for the girl's death, and recommended closing it down as it lacked the basic human resources and equipment required for functioning. It also recommended a case of manslaughter be registered against the managing director of the hospital. A Supreme Court bench is expected to hear the case this month. Imanae's death spurred the Maliks into action. In an unprecedented move, the family conducted press conference after press conference giving the media details of how Imanae was treated at the hospital.

Overnight huge billboards with Imanae's photograph and the words "I died because of criminal negligence" were put at major junctions all over the city. Bumper stickers showing the little girl staring innocently into the camera were plastered across Lahore. And hundreds of people turned up for candlelit vigils. It is not the first time that a case of medical misconduct has been filed against a private hospital in Pakistan, but it is the first time the public has become so galvanised, in part because of the campaign by the Maliks but also because of frustration at the creeping decline of the country's health service.

Prof Javed Akram, principal of Jinnah Hospital - a government-run institute in Lahore - said part of the problem is that many doctors preferred to work overseas, in part because of the current instability in the country. "The healthcare system of Pakistan is falling apart because a large percentage of doctors who graduate from medical hospitals here go abroad, most of them never to return," he said.

"The insecurity in Pakistan is pushing away hundreds and thousands of qualified medical professionals." Asked to estimate, Prof Akram said more than 50 per cent of the graduating class from the college he heads applies for fellowships abroad. He also said Pakistan's government was entirely focused on fighting terrorism, leaving little time for dealing with other issues. For Mr Malik, the aim of his campaign was not only to have the doctors who administered the fatal shot suspended and the hospital shut down, but to force the government to set up a regulator to oversee private hospitals.

Currently, there are no laws governing the establishment of private health care facilities in Pakistan: almost anyone can set up a hospital, anywhere they want to. Dr Ahmad Nadeem, a registrar of the Pakistan Medical and Dental Council, agreed that terrorism and its related challenges was one reason for the health care system faltering in Pakistan. "The government is completely engrossed in dealing with security issues," he said. "Legislative work in all areas, including health, has come to a standstill and to date there is no legislation in the Punjab province which is regulating a private hospital set-up."

Health professional organisations have also been calling for increased spending on health. Currently, the country is spending US$4 (Dh15) per capita on health every year while the minimum requirement is $34 per capita in order to ensure adequate provision of health services. One reason for the decreased spending is that the giant share of Pakistan's budget is spent on defence, which results in inadequate facilities at public hospitals.

Dr Nadeem said one of the reasons for the growth in private hospitals was that there was "simply not enough hospitals to cope with the growing demands of an exploding population". After Imanae's death, the chief minister of Punjab province has pushed for a health care bill which would include regulation of private hospitals. During his struggle to obtain justice for his only daughter, Mr Malik said he received "tremendous support and encouragement from the general public".

In less than a month, he says, he has received more than 5,000 e-mails from the public, including 250 from people who were also victims of botched health care. Mr Malik said he had been offered a "hefty sum" by the hospital to drop the case, but he has refused, saying all he cares about is justice for his daughter. "I don't need money, I don't need recognition and I don't need appeasement," he said. "I simply want justice - justice for Imanae."

* The National